LIHEAP Application

The Low-Income Home Energy Assistance Program (LIHEAP) helps eligible, low-income Navajo households living on the reservation pay their primary source of heating or cooling costs or with weatherizing their home to make it more energy efficient.

Application Priorities

Priority will be given to eligible applicants in the following order:

1. At least one eligible household member who is 60 years old and receiving disability income or has a disability that is verified by a physician or a federal agency
2. At least one eligible household member who is receiving disability income or has a disability that is verified by a physician or a federal agency
3. At least one eligible household member with young children who are five (5) years or younger

Required Documentation

Before you begin filling out the application, gather the required documents and be prepared to upload an electronic copy as part of this application (photos of physical documents are acceptable).

To determine your eligibility for assistance, verification is required for the items below. All documents must have matching names on your CIB, Social Security Card, W-9, and State ID/Driver’s License. If you do not provide all required documentation, your application will be denied.

Your application will not be accepted or processed without the required documents:

• Valid State Issued Driver’s License/ID – (Applicant)
• Social Security Card – (All Household Members; names must match this application)
• Certificate of Indian Blood – (All Household Members)
• Income Verification, including assistance from TANF, General Assistance, Social Security, SNAP/Food Stamps, etc. – (All Household Members)
• Proof of Residency – Chapter Verification (Applicant)
• Weatherization Only – Need three (3) current quotes from vendors
• If your name has changed, a marriage license or divorce certificate is required – (Applicant)
• Current W-9 Form – (Applicant) After submitting this application, you will be re-directed to fill out a W-9 Form online; your name must match on this LIHEAP application, the W-9, and required Social Security Card.

Please reach out to your local NDCFS office with questions or to submit any required documentation not uploaded today with your application; additional documents can also be uploaded online after your application is submitted:

2026 LIHEAP Application

Priorities

Do any of these priority conditions apply to your household?

At least one eligible household member who is 60 years old and receiving disability income or has a disability that is verified by a physician or a federal agency

At least one eligible household member who is receiving disability income or has a disability that is verified by a physician or a federal agency

At least one eligible household member with young children who are five (5) years or younger

FAU Agency(Required)

Select the FAU Agency location closest to where you reside (Required)

SelectCrownpointShiprockChinleFort DefianceTuba City

Name(Required)

First Middle Last Suffix

Education Level?(Required)

SelectNongraduateCurrent Student Pre-K-12High School Diploma/High School EquivalencyPostsecondary – no degreePostsecondary degree/certificate

Are you a veteran?(Required)

Yes

No

Email(Required)

Email of Applicant or Household Member (Required)

Phone Number(Required)

Physical Address(Required)

Street Address Address Line 2/Rural Address # City SelectArizonaNew MexicoUtah State Zip Code

Chapter Residency?

SelectAlamoAnethBaca/PrewittBecentiBeclahbitoBird SpringsBlack MesaBodaway/GapBreadspringsBurnhamCameronCasamero LakeChilchiltahChilchinbetoChinleChurchrockCoalmine MesaCoppermineCornfieldsCounselorCoveCoyote CanyonCrownpointCrystalCudeiDennehotsoDilconForest LakeFort DefianceGanadoGreasewood SpringsHard RockHogbackHouckHuerfanoIndian WellsInscription HouseIyanbitoJedditoKaibetoKayentaKinlicheeKlagetohLake ValleyLecheeLeuppLittlewaterLow MountainLukachukaiLuptonManuelitoMany FarmsMariano LakeMexican SpringsMexican WaterNageeziNahata DzilNahodishgish/Dalton PassNaschittiNavajo MountainNazliniNenahnezahNewcombOak SpringsOjo EncinoOlijatoPinedalePinonPueblo PintadoRamahRed Lake/NavajoRed MesaRed RockRed ValleyRock PointRockspringsRough RockRound RockSan JuanSanosteeSawmillSheepspringsShiprockShontoSmith LakeSt. MichaelsStanding RockSteamboatSweetwaterTachee/Blue GapTeecnosposTeestoThoreauTohatchiTolani LakeTonalea/Red LakeTorreon Star LakeTsaile/WheatfieldTsayatohTselani/CottonwoodTuba CityTwin LakesTwo Grey HillsUpper FruitlandWhippoorwillWhite RockWhiteconeWhitehorse LakeWide RuinsNot Applicable

Is your mailing address different from your physical address?(Required)

Yes

No

Mailing Address

Street Address or PO Box Address Line 2 City SelectArizonaNew MexicoUtah State Zip Code

Household Members

List of names and information for yourself and all the people who live with you.

Applicant Name(Required)

Applicant: Your Own Name (Required)

SSN(Required)

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

Self, Head of Household

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Amount

SNAP/Food Stamps Amount

GA Amount

SSA Amount

SSB Amount

SSDI Amount

SSI Amount

Would you like to add another household member?

Yes

No

Household Member 2

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 3

Full Name(Required)

SSN

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 4

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 5

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 6

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 7

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 8

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 9

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Would you like to add another household member?

Yes

No

Household Member 10

Full Name(Required)

SSN(Required)

Social Security # (Required)

Select(Required)

Relationship

Date of Birth

Gender

Census #

Disabled?

SelectMaleFemale

SelectYesNo

Income

Income Amount

Source of Income

Paid How Often

 

SelectDailyWeeklyEvery two weeksTwice a monthMonthly

Add Remove

Use the + at the end of the row for additional jobs

Assistance(Required)

Select all assistance received by your household:(Required)

TANF-Tribal Assistance for Needy Families

SNAP/Food Stamps

GA-General Assistance

SSB-Social Security Retirement Benefits

SSA-Social Security Survivor Benefits

SSDI-Social Security Disability Insurance

SSI-Supplemental Security Income

None of the Above

TANF Monthly Amount

SNAP/Food Monthly Stamps Amount

GA Amount

SSB Monthly Amount

SSA Monthly Amount

SSDI Monthly Amount

SSI Monthly Amount

Household Race(Required)

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian

White

Multi-race

Other

Household Ethnicity(Required)

Hispanic, Latino, or Spanish Origins

Not Hispanic, Latino, or Spanish Origins

Home Status(Required)

Rent with utilities billed separately

Rent with utilities in rental fee

Own

Board

Type of Assistance

Type of Assistance Requested(Required)

Heating

Cooling

Weatherization

Crisis – Service Reconnection

Cooling Fuel Type(Required)

Electric

Propane

Natural Gas

Heating Fuel Type(Required)

Wood/Coal/Pellet

Electric

Propane

Natural Gas

Describe your issue(Required)

Weatherization Type(Required)

Wood/Pellet Stove

Home Weatherization

HVAC Unit (heating, ventilation, & air conditioning)

Received past assistance?(Required)

Have you, or any member of your household, received similar assistance from another tribal, state, or local program? (Required)

Yes

No

Use the + at the end of the row to add more rows(Required)

What Assistance?

Who Received?

When?

 

Add Remove

Use the + at the end of the row to add more rows

Upload Required Documents

Your application will not be accepted or processed without the required documents.

Upload as much as possible digitally (photos of documents you don’t have in electronic format are acceptable), or you can email or bring in any additional documentation to an NDCFS office.

• Valid State Issued Driver’s License/ID – (Applicant)
• Social Security Card – (All Household Members; names must match this application)
• Certificate of Indian Blood – (All Household Members)
• Income Verification, including assistance from TANF, General Assistance, Social Security, SNAP/Food Stamps, etc. – (All Household Members)
• Proof of Residency – Chapter Verification (Applicant)
• Weatherization Only – Need three (3) current quotes from vendors
• If your name has changed, a marriage license or divorce certificate is required – (Applicant)
• Current W-9 Form – (Applicant) After submitting this application, you will be re-directed to fill out a W-9 Form online; your name must match on this LIHEAP application, your W-9, CIB and Social Security Card.

Uploaded Files

Upload Supporting Documents

Drop files here or Select files

Max. file size: 40 MB, Max. files: 30.

Self-Attestation(Required)

I understand and agree that the awarded LIHEAP funds will be my responsibility to pay for my Energy Assistance needs. My signature below attests that I will use the funds for the intended purposes and that the information provided is true and accurate.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

After submitting this application, you will be able to fill out the required IRS W-9 Form (only necessary if you did not upload one already).